New approach to mild cognitive impairment could prevent falls, provide other benefits
Early detection of cognitive impairment can help prevent falls and driving mishaps for individuals, and it also enables older adults and their families to make medical, financial and legal decisions in advance, according to the authors of a study presented at the annual meeting of the American Academy of Neurology. Additionally, early detection can save on long-term healthcare costs.
Currently, however, many primary care physicians are not diagnosing mild cognitive impairment because of a lack of knowledge of associated conditions and other reasons, the authors state in their abstract. Mild cognitive impairment is missed or miscategorized, so older adults are not referred to neurology specialists when clinically warranted.
The authors recommend a tiered approach to improve the situation:
- Adults aged more than 65 years should receive a minimal level of screening questions as part of their annual wellness visits.
- Those with concerns should undergo a problem-focused brain health visit with their primary care physicians, during which targeted questions, cognitive screening, laboratory assessment and, in some cases, neuroimaging are used to determine whether the person has mild cognitive impairment or dementia.
- When the doctor suspects a neurodegenerative condition, a dementia diagnostic visit with either a primary care physician or specialist should be conducted. This visit should include targeted questions, cognitive testing, laboratory assessment and neuroimaging focusing on diagnosing dementia.
- When symptoms have progressed rapidly, a visit with the primary care physician (including specific questions, laboratory assessment and decision procedures) should be conducted to rule out common causes of delirium.
- In rapidly progressive dementia, a neurologist should conduct a comprehensive visit for an older adult who is not delirious.